Yokosaki Miharuka, Nezu Tomohisa, Aoki Shirou, Yamazaki Yu, Maruyama Hirofumi
Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, JPN.
Cureus. 2025 Jun 5;17(6):e85410. doi: 10.7759/cureus.85410. eCollection 2025 Jun.
Bilateral vertebral artery dissection (VAD) is rare, particularly in the extracranial V1 segment. We report a case of bilateral VAD (V1 and V4 segments) in a patient with a vertebral artery anomaly, potentially triggered by the puerperium and high pillow use. A 35-year-old primiparous woman with a history of migraine developed worsening headaches after starting to use a high pillow. Computed tomography angiography revealed bilateral VAD in the V1 and V4 segments and a vertebral artery anomaly. Magnetic resonance imaging and ultrasound examinations confirmed a temporal phase difference in the intramural hematomas of both vertebral arteries. Despite having an anomalous vertebral artery for 35 years without dissection, the high pillow use during the puerperium is suspected to have triggered the dissection. Vertebral artery anomalies are present in a small percentage of the population and are not uncommon. When detected during routine health checkups, it is crucial to raise awareness of their potential risk for dissection and the importance of risk management. Furthermore, in cases of unilateral VAD, careful monitoring is warranted, as contralateral or multi-segmental dissection may be induced.
双侧椎动脉夹层（VAD）较为罕见，尤其是在颅外V1段。我们报告一例患有椎动脉异常的患者发生双侧VAD（V1和V4段）的病例，可能由产褥期和高枕使用引发。一名有偏头痛病史的35岁初产妇在开始使用高枕后头痛加重。计算机断层血管造影显示V1和V4段双侧VAD以及椎动脉异常。磁共振成像和超声检查证实双侧椎动脉壁内血肿存在时间相位差异。尽管该患者的异常椎动脉已存在35年未发生夹层，但怀疑产褥期使用高枕引发了夹层。椎动脉异常在一小部分人群中存在且并不罕见。在常规健康检查中检测到椎动脉异常时，提高对其夹层潜在风险的认识以及风险管理的重要性至关重要。此外，在单侧VAD的情况下，由于可能诱发对侧或多节段夹层，因此需要仔细监测。
